Provider Demographics
NPI:1417964859
Name:LUO, CATHY C (MD)
Entity Type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:C
Last Name:LUO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9928
Mailing Address - Street 2:350 E MILLSAP RD
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-0034
Mailing Address - Country:US
Mailing Address - Phone:479-587-1753
Mailing Address - Fax:479-587-8754
Practice Address - Street 1:350 E MILLSAP RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4098
Practice Address - Country:US
Practice Address - Phone:479-587-1753
Practice Address - Fax:479-587-8754
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4333174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARH72492Medicare UPIN
AR5N114Medicare UPIN